Autism Belongs by Dr. Sharon Mitchell; eBook 2015 Edition

Autism Belongs, Book 3 in School Daze Book Series, by Sharon Mitchell, eBook 2015 Edition; an Extended Review with < My Thoughts > by Sara Luker (Note: This is based on fictional characters.)

(13% indicates location in the Kindle version of the book, instead of page numbers.)Excerpts from the book ~

9% “Let’s go for a walk.” Tomas knew that his wife had been cooped up in the apartment for far too long. When Manny was younger, she used to take him out often, but as he’d grown bigger and stronger and more unpredictable, it was no longer safe for her to go out alone with him.​Tomas and Maria strolled along, careful where they placed their feet. From past experience they knew that the sound of crunching leaves sent their son off the deep end. They did not need to tell Manny; his footsteps automatically missed the fallen leaves, even when he seemed to be peering upward toward the sun’s rays.

They walked the same route every time – had to. Any deviation bothered Manny so badly. When he was younger, he’d throw himself to the sidewalk, flailing and wailing if they tried taking a different street. Tomas would simply hoist the screaming child over his shoulder and they’d head home. Now that Manny had some size on him, this was harder to do. Plus, strangers looked at a tantrumming two year old in one way, but a half grown child doing the same thing was an entirely different matter.

10% Immediately, Manny’s arms came up at his sides, his hands elevated and that keening noise started in the back on his throat. His parents knew what this meant. Manny might not speak, but he communicated, for sure. At least, sometimes.

< My Thoughts >“Communication…school age”

Franco, Davis & Davis (2013) believe that because children with autism don’t develop early ‘intentional’ communication skills, they will develop flapping and challenging behaviors such as hitting, as they grow older. They say that the older child needs to be taught three important communication behaviors: vocalization, eye gaze, and gestures. They are considered the basic components of prelinguistic ‘requesting’ and ‘commenting’ acts. That older children who may never develop complex spoken language can still increase a beneficial, clear consistent means of communication. Studies show that there are positive outcomes for communication treatment planning with older children.

10% “All right, son. I understand. Papa made a mistake is all. We’ll go straight.” He pointed down the way they had originally been heading. Manny’s noises stopped and he walked ahead of his parents on what he knew was the correct path. Tomas grabbed Maria’s hand and gave it a squeeze. “Just hang loose and it’ll be all right. Show him we’re relaxed and we’ll walk right on by.”

Nope, not gonna happen. That’s what Manny’s body language said. He planted himself firmly in front of the bakery window and pressed his nose to the glass. He made little noises but not the ominous ones that forewarned of an eruption. These were more like happy noises, contented ones. If all their son wanted was a quick peek in a bakery window, then Tomas and Maria would oblige. How long can you wait, nonchalantly regarding bakery goodies?

11% The gentleman was holding open the door. “Go in he said…” Inside the bakery, the woman behind the counter followed Manny’s gaze. “Got it. I see which one you want.” The man said, “That’s Ellie, she owns the place.”

The bell over the bakery door chimed. Running feet and a boisterous, high pitched voice announced, “Munchkin’s here!”

“Hello Munchkin. Just what did you do with my nephew, Kyle?

“I’m Kyle, silly.”

“Did you bring your mom and dad?” Mel and Ben hung up their coats and sat at the round table.

The man said, ”Mel, you might be interested in that boy over there…” Mel got his meaning. She was a teacher at a school for kids who learned differently.

13% Mel appeared at their table, kneeling beside Manny. She put a device on the table and rubbed her finger over the glass surface. The picture of the bakery snagged Manny’s attention.

14% “That’s called a social story. A woman named Carol Gray came up with the idea and it really works. I made that one for our son. He used to have trouble transitioning from one thing to another. If he liked something, he never wanted it to end. And, he really likes this bakery. So, we made a story for him. We’d read it before we’d come to the bakery and again when we got here. Then, I’d pull it out just before we were ready to leave. It worked and he got better,” Mel said.

“Our Manny, he does not read.”

“But he looks at pictures I noticed. You don’t need words to write a story. You can draw stick figures to illustrate what’s going to happen. Just tell him what the figures mean and what is expected of him.”

< My Thoughts >“Carol Gray ….social stories …”

Samuels & Stansfield (2011) remind us that part of the Autism diagnosis reveals the range of impairments in social functioning and social interaction difficulties. Social Stories were first developed by Carol Gray in 1991 as a strategy for sharing meaningful and accurate information about these problematic social situations. Social stories differ from direct social skills instruction by saying and showing what is expected to happen during a specific social event.

By guiding social behavior, this helps to overcome the fundamental problem of following and interpreting social rules. When the Social Story uses positive language to answer “wh” questions then the outcome is a ‘replacement behavior’. Identifying areas where an ‘age appropriate’ Social Story might be the most effective intervention is the key. (Note: “wh” questions are… who, where, what, when, why, and ‘how’ will you?)

14% Mel tried to explain. “Kids with autism take in things that they see easier than things that they hear. That’s why a story like this helps – the child does not just listen to what we’re saying but they see the visual of what is happening.”

“Kids with Autism? Oh, that’s not our Manny.”

It was Mel’s turn to look skeptical. She raised one eyebrow. “Where does he go to school?”

“He is not in school. He stays home with us.”

“May I ask why?”

“He is not like other children. He gets upset and he, well, he doesn’t talk.”

“I understand that he does not speak and that he might get upset, but that does not mean he can’t go to school.”

“No. we keep ourselves to ourselves. Manny is our responsibility. We will look after him.” “But, thank you again for your help…”

(Catching up with Tomas and Manny) “She told me that kids with autism like to look more than listen, or something like that.”

< My Thoughts > Visual learners…

Erdodi, et al. (2012) reported that persons with ASD generally have better visual than verbal ability. But, this can depend on the novelty or complexity of the presentation of the new information. Auditory verbal learning, they point out, results in yet another pattern of performance; such as taking extra time and learning context clues. Also, because students can’t seem to organize well, they will have difficulty learning visual lists of words.

The reasons for visual learning preferences, according to Sokhadze, et al. (2017) may be that the thinking (cognitive) activity is related to working memory, which is triggered by visual stimuli. And, because of the abnormal brain connectivity in persons with ASD, it explains why visual details are more important than the picture as a whole. ‘Response selection’ can also be influenced by the novelty of the stimuli. Therefore, a person with ASD will more easily pay attention to a visual prompt before an auditory one. Studies show that a ‘novel’ visual prompt will draw even more response.

14% “Autism?”

“That’s what she said.”

“Wonder why she’d say the word autism if you were talking about Manny, or about her son?”

29% “We were fine, Tomas, although I admit that this is much nicer, these walks and going to the bakery and talking to people. Do you think Manny likes it, too? Is that why he’s calmer because he’s getting out and doing different things?”

”I’ve never thought of it before. Do you think it’s possible that a kid like Manny could get bored?” with a sleepy Manny bathed, cuddled and tucked into bed, Maria and Tomas had time to themselves.

Maria broached the subject that had been on her mind. “Tomas, what do you know about autism?”

“Not much. I saw that old movie, Rainman when I was a kid. I think on television I’ve seen scenes of people who rock back and forth, bang their heads, and are lost in their own worlds. Why?”

“Because several people now have mentioned autism and Manny. I think they think that he’s autistic.”

“No, that can’t be. No. they don’t know our son. He’s not hopeless like those people.”

“You know Jeff – the guy at the bakery who cooks and fixes computers?”

“Yesh, didn’t they introduce him as Mel’s brother?”

“Yes. He has autism.”

“No, that’s not right. He can’t.”

“He told me so himself today. He seems definite about it. And, he says that Kyle, Mel’s son has autism also.”

Maria shifted her head on Tomas’s shoulder so she could look at his face in the moonlight. “He says that all people with autism are different and that that view I had of autism is only one part, a small part of autism. Jeff says that autism is just one of his characteristics.”

I’ve seen Kyle there. He seems like every other kid.”

According to Jeff, he’s a kid who has autism.”

< My Thoughts > “Looks so normal…”

​Hoogsteen & Woodgate (2013) say that “…autism was invisible to the untrained eye yet visible in ways that people deemed as undesirable.” “They have no clue because “C” looks perfectly normal. He walks. He talks. He doesn’t have, you know, a stumble or a limp, so you can’t see a physical disability.”

Green (2013), in her review of various articles, discovered that much of the literature brings up the ‘invisibility of autism’. Families seem to experience long-term stress and anxiety because of experiencing societies’ expectations of the person with autism, the ‘invisible disability’ looking so normal.

29% They were silent for a while. Then, Tomas asked, “What makes Jeff think that Manny could have autism?”

Tomas digested thin information. “Why do you think he does those things?”​“I asked Jeff that if Manny did have autism, would he ever be like Jeff. He said that Manny will need help – special help.” “Then he asked me why Manny is not in school.”

33% “You have been most kind to us. Certainly, we should like to hear what you have to say.”

Mel studied him carefully. “Well,” she began, “life can be especially frustrating for kids who don’t talk. They have no way to make their wants and needs known. Often, it’s up to the parents to play a guessing game; sometimes we are not very good at it, frustrating the kid even more.”

“Tomas nodded. “We see this often, but don’t know what to do. If only he’d just say what it is he’s after.”

​“Sometimes we use pictures with kids who can speak to us…”

< My Thoughts > “PECs & Visual Schedules…”

​Picture Exchange Communication System (PECS) uses picture symbols (visual supports on cards, pages or in books) to teach communication skills. The learner is taught to use picture symbols to ask for objects or activities, ask and answer questions, and have a conversation. In 20 – 30 minute sessions, children learn a communication system where they exchange different symbols with a partner as a means to communicate a ‘want’. This intervention is taught in six phases by a trained ‘communicative partner’ and has ‘visual supports’ which can be made or purchased readymade.

Picture Exchange Communication System (PECS) is a great tool in helping all nonverbal children with or without autism communicate without words. PECS is used in a variety of ways–starting with pictures–to allow the child to make choices and communicate his/her needs. When children can communicate and express their needs, behaviors often can be minimalized resulting in a much happier child.

At school, they started Sonny on the PECS system of communication when he was about 8 years old. At first we used the PECS graphics for the items but when he didn’t respond to them, we switched to pictures cut from ads. He is very much a visual learner so I can understand why he liked to see the real image.

The problem for Sonny was that he was not high-functioning enough, nor was he coordinated enough (fine-motor skills such as using pincher fingers…which ASD children often hate to do) to scan a selection of cards…make a choice that fit his needs…and present it to someone in exchange for the item. Too many variables for him, and (big AND) we didn’t know he was having undetectable seizures. Epilepsy was not on the radar at that time.

51% Mel continued. “It’s tough for kids who are nonverbal. They can’t tell us what they want or need, so we have to become keen detectives, watching their behavior and using trial and error.

60% “There is no pill that will make the autism all go away. Sometimes some kids are helped by some meds that allow the child to pay attention better or remain calmer so that they are better able to learn, but it is definitely not automatic that if a child has autism, he will take medication.”

< My Thoughts > “Medication for autism…”

Behavioral interventions have been proven effective and usually approved by most insurance, including Medicaid, medications for autism is another story; especially for older children. Lenne & Waldby (2011) separate the two interventions by arguing that unlike other ‘disorders’ there is a lack of biological markers or pathology tests to verify the need for a certain medication. There are no clinical practice guidelines or evidence-based medicines found to work for both geniuses and those with extreme impairment. Instead, pediatricians face the complexities and inconsistencies of seeing autism in the clinical setting. Many, it is said, are left to go with their ‘sixth sense’ or ‘gut feeling’ when interacting with patients.

Williamson, E. & Martin, A. (2012) designate three main clusters of conditions which have widely prescribed medications: irritability; (ADHD) Attention Deficit Hyperactivity Disorder-like symptoms, and repetitive behaviors. A cautionary tale, these medications have not been studied for the treatment of autism. They do not treat the underlying disorder of autism, and do have prominent negative, as well as positive side effects. Also important would be that parents see to regular monitoring of vital signs and laboratory tests, appropriate attention to diet and lifestyle changes. They add the comment that while two decades ago, autism was considered to be a result of dysfunctional parenting, now autism is treated as a neurodevelopmentaldisorder.

60% “What do we do now?”

Mel returned to the report – “Pretty standard stuff. Exposure to other children, follow the recommendations of a speech/language pathologist, referral to an occupational therapist for follow-up on sensory strategies, social skills training, maintain a language-rich, structured environment, support routines with visuals and work closely with your school.”

“There is not one thing listed here that we don’t do at school and do well. You won’t need to take time off work to run Manny to appointments; the therapists will come right to the school. And, when they aren’t there the school staff will carry on with the programming these specialists lay out.”

“And all this would happen at school.”

“Definitely. All this and much, much more.” Mel’s encouraging expression contrasted with that of the anxious mother and father in front of her.

61% (On the iPad) Manny was watching the story Mel had made about Manny going to the pizza party at school with Kyle.

< My Thoughts > “Social Stories on the iPad…”

Debbie Lee, Assistant Professor in Western Illinois University Education Dept., has reviewed iPad Apps, including those for Social Stories. She recommends demonstrations of these on You Tube, or on other websites, in order to find the one that will work for you.

61% “It’s been a good morning… he’s nice and relaxed.” As the video ended Tomas instructed, “Time to get your coat, Manny. We have to leave now if you’re going to eat pizza with Kyle.”

The first face that greeted them belonged to Mel. She knelt down to eye level with Manny, gave him a soft hello...

Then, a small head ducked out of the classroom door. Kyle.

“Manny, come on, aren’t we ever going to eat? We’re waiting for you.”

< My Thoughts > School on the Short Bus… and… Diagnosis, Denial & Doctors.​Mandell & Novak (2005) tell us that cultural influences, experiences with the health system and parents’ beliefs play a role in whether or not a child ever is diagnosed. Often times, they say, parents don’t even know they should be making a decision about their child. Or, they assume that “He’ll grow out of it.” And then, Latino children who are diagnosed were six times more likely to have parents who sought non-traditional treatments. Added to that, the authors believe that clinicians may delay treatment or diagnosis because they don’t believe the parents will be successful in following-through with recommended interventions.

End of excerpts from this book...==============REFERENCES used in < My Thoughts > are:

Samuels, R., Stansfield, J. (2011). The effectiveness of Social Stories to develop social interactions with adults with characteristics of autism spectrum disorder, British Journal of Learning Disabilities; V40, p 272-285.